Health and Social Care Update - February 2010

This Update prepared by Claire Bentleycontains brief details of recent Government publications, legislation, cases and other developments relevant to those involved in health and social care work, which have been published in the last month.

This Update contains brief details of recent Government
publications, legislation, cases and other developments relevant to
those involved in health and social care work, which have been
published in the last month.

If you have been forwarded this update by a colleague and would
like to receive it directly, please email Claire Bentley.

Publications/GuidanceDelivering better care at end of life. This
report includes papers given at the Sir Roger Bannister Summit,
arranged for those responsible for implementing the government’s
End Of Life Care Strategy. It covers issues including
commissioning, hospice and hospital care, quality markers,
challenges for providers, and an account of the debate generated
and identifies ten actions to help the successful implementation of
the strategy

Use of medication in care homes. This letter
describes recently published research commissioned by the
Department of Health as part of the patient safety programme. The
research identified considerable scope for improvement of
prescription, dispensing, administration and monitoring of
medicines in care homes.

End of life care manifesto 2010. The National
Council for Palliative Care (NCPC) have launched their end of life
care manifesto, warning that without continuing radical change in
the way Britain cares for dying people, increasing numbers of older
people are likely to die in a distressing manner without good
care.

ConsultationsCharging arrangements for residential social care:
consultation on issues concerning the current charging arrangements
for residential social care. The Department of Health invites
views on proposed amendments to the following: the National
Assistance (Assessment of Resources) Regulations 1992; the National
Assistance (Residential Accommodation) (Additional Payments and
Assessment of Resources) (Amendment) (England) Regulations 2001;
the National Assistance (Residential Accommodation) (Relevant
Contributions) (England) Regulations 2001; and the Charges for
Residential Accommodation Guidance. Views are sought in particular
on changes regarding the treatment of personal injury compensation;
the treatment of single premium investment bonds; the introduction
of a new disregard for pre-paid funeral plans; and deferred
self-top ups during the 12 week property disregard. Comments by
April 23, 2010.

LegislationPersonal Care at Home Bill. The Personal Care
at Home Bill was announced in the Queen's Speech on 18 November
2009 and has received its second reading in the House of Commons.
The Bill guarantees free personal care for the 280,000 people -
including those with serious dementia or Parkinson's disease - with
the highest needs. It is anticipated that, subject to the passage
of the Bill and the introduction of regulations, free personal care
could be introduced from 1 October 2010.

If you wish to discuss any of the items raised in this section
please contact
Neil Grant.

Keeping Children and Young People in Mind. This
leaflet summarises the government’s full response to the review of
child and adolescent mental health services and sets out the
features of good services that all local areas should be working
towards delivering.

Publications/GuidanceStandards for the management of sexually
transmitted infections. These standards provide a framework for
monitoring performance which covers the core principles of STI
care, staff training, clinical assessment and management,
diagnostics, information governance, links to other services,
clinical governance and the engagement of patients and the
public.

EEA bodies who will issue a Provisional Replacement
Certificate (PRC). Overseas visitors receiving clinically
necessary treatment who fail to provide an EHIC, should be asked to
obtain a PRC from the appropriate liaison body in the competent
member state. A PRC provides the same access to free treatment as
if it was an EHIC. PRC details should also be recorded and reported
for a claim to be made. A list of providers of PRCs is now
available.

Guidelines for the Clinical Management of People
Refusing Food in Immigration Removal Centres and Prisons. This
document provides information for health professionals in prisons
and immigration removal centres on the physical effects of food
refusal, the most effective practical and clinical management of
individuals refusing to eat and drink, legal aspects and the
relevance of the Mental Capacity Act 2005. It also addresses the
considerable dangers and risks associated with re-feeding
individuals who have been starving but who then decide to eat
again.

NewsTop British designers and architects to improve
privacy and dignity in NHS hospitals. The Government has
launched the new Design for Patient Dignity project which teams up
the DH with the Design Council to bring together some of the best
minds in the design industry with those working on the frontline in
the NHS, as part of a programme of works by the DH to improve
patient privacy, dignity and care experience. Six teams of leading
UK product, interiors, fashion and systems designers, architects
and manufacturers have been appointed to work on a range of briefs
that will help to improve the hospital environment and patient
experience, such as new ward layouts, more dignified toileting and
washing facilities, and new ways of improving the physical and
emotional security of patients being transferred within
hospitals.

Publications/GuidanceEngaging and responding to your community - a brief
guide to Local Involvement Networks. Local Involvement Networks
(LINks) exist in every local authority area of England to give
people more influence over how their local health and social care
services are planned and delivered. This guide for health and
social care managers explains more about LINks. It outlines
how, through proactive engagement they can better understand the
needs of their community. It highlights how working with the LINk
should be a key part of commissioning, running and reviewing health
and social care services.

Final report of the Expert Group on Commissioning
NHS Infertility Provision. This is the final report of the
independent expert group on commissioning NHS infertility
provision. The key points include:
· the development of a national tariff for regulated fertility
services
· a project to share information on local prices and tariffs on an
anonymised basis to help PCTs assess whether their local prices are
a fair reflection of the national pattern
· sharing information gained from research to help
commissioners
· the availability of support for commissioners from expert
patients.Promoting health and well-being: reducing
inequalities. This guide has been developed to assist
commissioners to make the most of the best methods of promoting
health, using the latest understanding of how they can support
people to make healthy choices as individuals within the social and
environmental contexts in which they live. The guide will also be
of value to providers in giving insight into the commissioning
process.

Regional trauma systems: interim guidance for
commissioners. This document aims to provide generic
information on trauma and trauma systems, and presents a proven
practical and evidence-based model suitable for regional trauma
systems in the UK. It is aimed at regional commissioners and other
stakeholders involved in the assessment of the provision of trauma
care and the reconfiguration of services to regionalised trauma
systems.

Education commissioning for quality. This
document outlines an enhanced, comprehensive education
commissioning system for non-medical and medical staff, sets
principles for managing relationships between health and education
more effectively, and provides guidance to build SHAs.

Delivering better care at end of life. This
report includes papers given at the Sir Roger Bannister Summit,
arranged for those responsible for implementing the government’s
End Of Life Care Strategy. It covers issues including
commissioning, hospice and hospital care, quality markers,
challenges for providers, and an account of the debate generated
and identifies ten actions to help the successful implementation of
the strategy.

Bevan Brittan Portal - New!
At Bevan Brittan we have set up an e-portal to assist complaints
managers in the NHS. The portal is of use to all NHS complaints
managers who are often handling very sensitive and complex work. It
provides tailored access to a range of up-to-date knowledge and
information enabling you to have a central, structured and focused
source of information on complaints.

It also has a discussion forum for use by complaints
managers to share tips and knowledge with each other.
You may like to
take a look at the forum and see what colleagues have posted about
different topics. In
addition you may want to write a post/query of your own.

Publications/GuidanceHelping trusts embed the NHS Constitution
locally. The Department of Health (DH) has produced a number of
materials to help NHS organisations embed the NHS Constitution and
NHS Values at a local level. From 19 January 2010, all NHS
organisations are under a legal obligation to have regard to the
NHS Constitution in all their decisions and actions. Access the
materials and case studies from NHS Employers' staff engagement web
pages.

ConsultationsReview of European Working Time Directive and
impact on training. Medical Education England is reviewing the
European Working Time Directive and its impact on the quality of
training for doctors, dentists, pharmacists and healthcare
scientists. NHS chief executives who wish to submit views are
invited to do so by 15 February 2010.

LegislationThe Equality Bill: Duty to reduce socio-economic
inequalities - a guide. This document is designed to form a
bridge between the wording of the duty, which was published in the
Equality Bill in April 2009, and the draft statutory guidance to go
with it, on which the Government will be consulting in Summer 2010.
It explains the background to the duty, the need for it, and how it
will operate for each of the different types of public body that
are covered by it. It also explains how compliance with the duty
will be monitored, and answers the questions that have been put to
the government in its discussions with stakeholders.

NewsNHS staff survey Wave Four. This letter from
Director of NHS Communications Colin Douglas states that the
Department of Health has commissioned GFK, an independent research
agency, to conduct a survey among NHS staff, including clinicians
and nursing staff in primary and secondary care, administrative
staff and senior clinical and non-clinical managers, across
England.

Over 3,000 doctors will test a new system of strengthened
appraisal intended to provide assurance on whether they are
up-to-date with medical advances and fit to practise. The pilot
scheme, which will cover doctors working in a wide range of NHS
healthcare settings across England, will begin in January 2010 and
run through to March 31, 2011.

Bevan Brittan Updates
Who is an “affected employee” for the purposes of
TUPE? The recent case of Unison v Somerset County Council
(1) Taunton Deane Borough Council (2) and South West One Ltd (3)
has provided some much needed guidance as to who is an “affected
employee” for the purposes of a TUPE transfer. Sarah Lamont
explains more.

NHS reference costs 2008/9. These documents
provide details of how, and on what, almost £48 billion of NHS
expenditure was used in the 2008/9 financial year.

Funding and performance of healthcare systems in
the four countries of the UK before and after devolution.
Political devolution means there are now four National Health
Services in the United Kingdom. The health services of England,
Scotland, Wales and Northern Ireland are all funded by the UK
taxpayer, but have developed different systems of governance and
different methods of providing healthcare. This report examines the
impact of this by studying key performance indicators for the NHS
in England, Scotland, Wales and Northern Ireland at three time
points – 1996/7, 2002/3 and 2006/7. The report also undertakes a
completely new comparison of NHS performance in the English regions
and the devolved countries. This is the first time such an analysis
has been conducted.

NewsHospitals must cut services to stay afloat,
watchdog warns. William Moyes, who stepped down as executive
chairman of Monitor in the week beginning 25 January 2010, has
warned that hospitals will have to reduce services, sell off
buildings and move into smaller premises to cope with financial
pressure in the next few years. While political parties have
promised to protect NHS funding and avoid service cuts, Mr Moyes
said it was inevitable that some hospitals would have to make cuts
to stay afloat.

Income Generation – Charging and Trading. In this latest
article looking at the legal challenges facing public sector
organisations to deliver Smarter Government and Operational
Efficiency, we consider opportunities for income generation. Whilst
efficiency savings are achievable through a range of difficult and
potentially unpalatable methods, income generation is achievable by
identifying additional areas where charges can be imposed or
increased or through outright trading.

Shared Services – Drivers, Challenges and Options.The term “shared services” is increasingly being used
in the context of local authorities and health bodies to refer to
collaboration between different autonomous public sector
organisations which is designed to improve efficiency/reduce
costs/fight off enforced restructuring. It is also often used in
the context of public sector bodies collaborating with each other
in order to procure a private sector partner for the provision of
some services through outsourcing or the delivery of asset schemes.
Regardless of the context used, the pressure on public authorities
to collaborate is increasing. The need to find further efficiency
savings will inevitably force organisations to look again at the
opportunities to deliver services more
effectively.

If you wish to discuss any of the items raised in this section
please contact
Claire Bentley.

Publications/GuidanceGovernance of equalities, diversity and human
rights diagnostic. The Audit Commission have developed a new
governance tool to help organisations improve the well-being and
outcomes for citizens and users who need it most and strengthen
their capacity to deliver equalities, diversity and human rights
priorities.

CasesR (on the application of Butler & Anor) v HM
Coroner for the Black Country District [2010] EWHC 43 (Admin).
Whilst a coroner's powers as to the scope of investigation during
an inquest were wide, they were not unlimited. Where a forthcoming
inquest was to be in the "traditional" style, involving
consideration of the means by which the deceased came to his death,
rather than issues of accountability or responsibility for the
death, the coroner had adopted an unlawfully wide approach in
indicating that evidence from police officers and health and safety
evidence should be adduced and that a verdict of unlawful killing
could properly be left to the jury.

ConsultationsHealth Protection Regulations: consultation
report. This is the response to a DH consultation which sought
comments on proposals for three sets of regulations to be made
under the amended Public Health (Control of Disease) Act 1984,
taking forward the modernisation of health protection law. The
regulations cover notification of hazards, safeguards for
individuals and updated local authority powers. Subject to
Parliament, it is planned that the regulations will come into force
on 6 April 2010 (except certain provisions in the Notification
Regulations which are planned to come into force on 1 October
2010).

NewsTop British designers and architects to improve
privacy and dignity in NHS hospitals. The Government has
launched the new Design for Patient Dignity project which teams up
the DH with the Design Council to bring together some of the best
minds in the design industry with those working on the frontline in
the NHS, as part of a programme of works by the DH to improve
patient privacy, dignity and care experience. Six teams of leading
UK product, interiors, fashion and systems designers, architects
and manufacturers have been appointed to work on a range of briefs
that will help to improve the hospital environment and patient
experience, such as new ward layouts, more dignified toileting and
washing facilities, and new ways of improving the physical and
emotional security of patients being transferred within
hospitals.

Better protection for vulnerable adults. The DH
has announced that it is planning new legislation requiring every
local area to have in place a Safeguarding Adults Board – a body
made up of the local social services authority, the police, the NHS
and working with all other groups involved in protecting vulnerable
adults. The Board will ensure that vulnerable adults who suffer
abuse will have quick and easy access to the people who can help
them best. The announcement follows the publication of Safeguarding adults: report on the consultation on
the review of No Secrets.

The UK is to officially recognise April 28 as Workers Memorial
Day to commemorate those who have died, been seriously injured or
made ill through their work. the day has been informally recognised
since 1992 and it is hoped that the official recognition will raise
awareness.

If you wish to discuss any of the items raised in this section
please contact
Adam Kendall.

LegislationCoroners and Justice Act 2009. An Act to amend
the law relating to coroners, to investigation of deaths and to
certification and registration of deaths; to amend the criminal
law; to make provision about criminal justice and about dealing
with offenders; to make provision about the Commissioner for
Victims and Witnesses; to make provision relating to the security
of court and other buildings; to make provision about legal aid and
about payments for legal services provided in connection with
employment matters; to make provision for payments to be made by
offenders in respect of benefits derived from the exploitation of
material pertaining to offences; to amend the Data Protection Act
1998; and for connected purposes.

CasesR (on the application of Butler & Anor) v HM
Coroner for the Black Country District [2010] EWHC 43 (Admin).
Whilst a coroner's powers as to the scope of investigation during
an inquest were wide, they were not unlimited. Where a forthcoming
inquest was to be in the "traditional" style, involving
consideration of the means by which the deceased came to his death,
rather than issues of accountability or responsibility for the
death, the coroner had adopted an unlawfully wide approach in
indicating that evidence from police officers and health and safety
evidence should be adduced and that a verdict of unlawful killing
could properly be left to the jury.

NewsA coroner has said that surgeons who live too far
away from hospitals are putting patients' lives at risk.
Greater Manchester coroner John Pollard has written to the National
Patient Safety Agency (NPSA) citing the case of a man in which a
contributing factor to his death was delays from the on-call
surgeon and anaesthetist to get into hospital. Both doctors lived
more than 40 miles away from the hospital they were working at. NHS
Employers head of programmes David Grantham said: "It is a national
requirement for key medical staff who undertake emergency 'on-call'
work to live a reasonable distance or travel time from their
workplace."

Publications/GuidancePostnote: diagnosing dementia. This briefing
outlines current diagnostic practices, research into newer tools
and service provision proposals that aim to increase early
diagnosis of dementia.

Keeping Children and Young People in Mind. This
leaflet summarises the government’s full response to the review of
child and adolescent mental health services and sets out the
features of good services that all local areas should be working
towards delivering.

'Count me in' census 2009. The Care Quality
Commission (CQC) has published this report which recommends that
the NHS, councils and wider community bodies should work together
to improve preventative services to ensure that they meet the
mental health needs of people from black and minority ethnic
groups. To reduce the risk of admission and detention, the report
underlines the need for better needs assessments and bespoke
community-based services.

Overarching report of findings from the Adult
Autism Strategy consultation activities. The consultation on
the future strategy for adults with autistic spectrum conditions
(ASC) closed on 15 September 2009. Over 1,100 responses were
received, including from people with ASC, families and carers,
voluntary sector organisations and health and social care bodies.
This document is a summary of the findings from the consultation,
setting out the approach taken, and the key themes and priority
actions identified by respondents.

Improving dementia services in England: an interim
report. According to this report, dementia has not been given
the support expected after publication of the Department of
Health’s dementia strategy, Living well with dementia, and there is
a risk that value for money will remain poor unless these
weaknesses are addressed.

NewsTop British designers and architects to improve
privacy and dignity in NHS hospitals. The Government has
launched the new Design for Patient Dignity project which teams up
the DH with the Design Council to bring together some of the best
minds in the design industry with those working on the frontline in
the NHS, as part of a programme of works by the DH to improve
patient privacy, dignity and care experience. Six teams of leading
UK product, interiors, fashion and systems designers, architects
and manufacturers have been appointed to work on a range of briefs
that will help to improve the hospital environment and patient
experience, such as new ward layouts, more dignified toileting and
washing facilities, and new ways of improving the physical and
emotional security of patients being transferred within
hospitals.

A study published in the journal Archives of Internal Medicine
suggests that elderly people should train with weights to help them
carry out everyday tasks and improve their concentration. The
research looked at group of women with an average age of 70 and
asked a portion of them to take a class using weights once or twice
a week. It found these women had a 13 per cent better level of
cognitive function than women who took a toning and stretching
class.

If you wish to discuss any of the items raised in this section
please contact
Simon Lindsay.

Publications/GuidanceThe standard NHS contracts for acute hospital,
mental health, community and ambulance services and supporting
guidance 2010/11. The NHS standard contracts for Mental Health
and Learning Disability, Ambulance Services, Acute Hospital and
Community Services were published on 18 January 2010 and will apply
to agreements between PCTs and all types of provider delivering NHS
funded services from April 2010. The contracts support the NHS
Operating Framework for 20010-2011 and should be read in
conjunction with the Principles and Rules for Co-operation and
Competition and the PCT Procurement Guide. A model consortium
agreement and associated guidance have been updated and are
published alongside the contracts. A standard format national
variation will be issued for use by PCTs and providers on existing
contracts, which will reflect the policy priorities outlined in the
2010/2011 Operating Framework.

Guidance for GPs on private screening. The UK National
Screening Committee has launched its guidance for GPs on private
screening. This guidance is designed to inform GPs about the issue
of screening, in order to help with advising patients about private
screening services.

Immunisation survey. This letter from Senior
Campaigns Manager of NHS Immunisation Information Steve Thorogood
highlights a research programme to examine the attitudes and
awareness of primary care givers to immunisation.

NewsGP extended opening hours. PCTs are expected to
continue expanding extended opening hours in GP practices,
particularly for patients of practices who are not offering this
service. This letter gives more information. The current DES rolls
forward in 2010/11 and PCTs are asked to submit plans saying how
they will make full use of the resources available for extended
opening.

Bevan Brittan Updates
Update - Transitional arrangements for the HESC Chamber. The
Family Health Services Appeals Authority was abolished on 18
January 2010 and its functions transferred to the Health,
Education and Social Care (HESC) Chamber of the First-tier
Tribunal. This Update informs PCTs of the transitional arrangements
for cases that are pending on the date of transfer and for new
cases after that date, and advises them on the practical steps that
they should take.

Guidelines for the Clinical Management of People
Refusing Food in Immigration Removal Centres and Prisons. This
document provides information for health professionals in prisons
and immigration removal centres on the physical effects of food
refusal, the most effective practical and clinical management of
individuals refusing to eat and drink, legal aspects and the
relevance of the Mental Capacity Act 2005. It also addresses the
considerable dangers and risks associated with re-feeding
individuals who have been starving but who then decide to eat
again.

News
Ministry of Justice figures reveal that almost 100,000 criminals
were jailed in 2008, a rise of 5 per cent on 2007. According to the
statistics, 141,000 people were sentenced to custody in 2008 - the
highest number since 1979 - despite falling crime levels.

If you wish to discuss any of the items raised in this section
please contact
Nadia Persaud.

Bevan Brittan Training - February 2010
Preparing for the New Regulatory System: Registration, Inspection,
Compliance and Enforcement. During the course of 2010 onwards,
the Care Quality Commission will extend the scope of its regulatory
remit over providers of health and adult social care services in
both the public and independent sectors. All providers who
undertake “regulated activities” will be required to be properly
registered under the Health and Social Care Act 2008. The key
changes will be:- NHS Providers: registration
which, to date, has been based solely on compliance with the Code
of Practice on Healthcare Associated Infections (HCAIs), will be
extended from April 2010 and measured against a new set of
requirements and standards governing all aspects of the running of
the organisation. These requirements will replace the
Standards for Better Health. Social Care and Independent Healthcare
Providers: from October 2010 (on the basis of the current
timetable) services will require registration under the 2008
Act, rather than the Care Standards Act 2000.
This will mean:- A wider scope of services requiring
registration. Applications having to be made for
registration to enter the new system. A new set of registration requirements
and guidance to comply with. A new judgment tool which will inform
regulatory decisions. Wider and more robust enforcement tools
for the regulator.

Following on from our successful October 2009 seminars on
regulation, Bevan Brittan is running three additional free training
sessions on the New Regulatory System at our Birmingham office from
10am - 12.30pm on 24 February 2010, at our London office from our
London office from 10am -12.30pm on 3 March 2010 and at our
Bristol office from 10am -12.30pm on 4 March 2010.

If you wish to discuss any of the items raised in this section
please contact
Neil Grant.

Conservative Party: A healthier nation - policy
green paper no.12. Sets out the Conservatives' manifesto on
public health, in which they state that they will devolve much
greater responsibility for tackling problems like obesity, drug use
and teenage pregnancy to communities . It includes proposals for
localised funding that will separate the public health budget from
the budget for NHS services and devolve much more of the public
health budget to local authorities and their health service
partners. They will be paid a public health success payment for
tackling problems like infant mortality, childhood obesity and
sexually transmitted infections, and given financial rewards for
reducing the future burden of disease and cost. Also, local
directors of public health will manage budgets and will be obliged
to commission local bodies, like schools, businesses, councils and
GPs, to promote healthy living. With money behind them, they will
have the power to recruit and pay innovative local organisations,
whether businesses or charities, to start to implement new ways of
promoting healthy choices and behaviour.

Civil Litigation Costs review - Jackson report.
Lord Justice Jackson's review of civil costs litigation, published
on 14 January 2010, proposes wide-ranging reforms including:
increasing damages in personal injury and other civil claims by 10
per cent; capping success fees in "no win no fee" cases at 25 per
cent, payable by claimants from damages; scrapping referral fees
paid by lawyers to claims companies; ending the principle of "loser
pays"; fixed fees for accident claims up to £25,000; and annual
reviews of lawyers' hourly rates and fixed costs. See the Law Society response, Bar Council response and the Judicial web site.

Choosing your Hospital leaflets and poster.
These documents explain the right to choose from any hospital in
England (including some independent hospitals) that offers suitable
treatment at NHS standards and costs.

Leading together better. This IDeA-sponsored report
explores the nature of partnership working between local authority
Directors of Adult Services, Children's Services and Public Health.
It aims to promote a discussion about the role of other council and
public services in promoting health and tackling health
inequalities. It focuses on how collaboration can be improved and
how other key strategic partners can be better engaged in improving
health. It reveals a positive picture of partnership working to
improve health outcomes.

The new EU Remedies Directive: proven procurement
is of the essence. New EU rules which improve access to rapid
and effective review procedures for suppliers who allege that
public authorities have breached procurement rules have taken
effect in the UK. This briefing aims to raise awareness amongst NHS
managers involved in procurement of the key changes to the rules
and to highlight new provisions in the law which public authorities
can use to protect themselves from challenge.

NewsNHS Constitution now backed by law. All NHS
organisations must have regard to all the rights and pledges in the
NHS Constitution when making decisions about the services they
provide to patients, as from 19 January 2010, under the Health Act
2009.

Support for thalidomide survivors. The
Secretary of State for Health Services Mike O'Brien has announced
that the Government will fund a £20m three-year pilot scheme to
address the health needs of Thalidomide survivors. The scheme will
be operated by the Thalidomide Trust.

Tax Health Plan. Medical professionals who contact HM
Revenue and Customs (HMRC) by March 2010 to make a voluntary
disclosure will be able to put their tax affairs in order simply
and on the best available terms under a new Tax Health Plan which
will operate in two stages: from 11 January to 31 March 2010,
medical professionals can register their intention to make a
voluntary disclosure with HMRC; and by 30 June 2010, those who have
registered must have made their disclosure as well as arrangements
to pay all tax interest and penalties due. The HMRC will carry out
targeted investigations aimed at medical professionals who have not
come forward by 31 March 2010 and substantial penalties or even
criminal prosecution could follow for those who have undeclared tax
liabilities.

Department of Health appoints Clinical Director for
Informatics. Announces that Charles Gutteridge, Medical
Director at Barts and the London Trust and a consultant
haematologist there and at Newham General Hospital, has been
appointed as the first national clinical director for informatics.
He will take up his appointment in January 2010.

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